• The ACOG Publishes New Birth Recommendations

    21 April 2017
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    According to the American College of Obstetricians and Gynecologists, “widely accepted, currently-used labor and birth interventions are not necessarily the safest care for women and babies.”

    You read that right.

    In February (2017), the ACOG released a new committee opinion that common labor and birth interventions should not be used on low-risk pregnancies. If you are currently pregnant and fall into this low-risk category, it is of utmost importance that you educate yourself on these recommendations. It typically takes the medical field years to come up-to-date and follow through reliably.

    The ACOG recommends that low-risk pregnant women seek individualized care as opposed to common obstetrics practices. These doctors are trained and capable of handling more intricate pregnancies and are quick to intervene when it is not necessary.

    The committee also recommends the following:

    Stay home until “active” labor

    This is around 6 cm dilated but can be witnessed as a shift in the labor. The mother moves into a more serious role and contractions become stronger and more frequent. Waiting until this time helps prevent an unneeded c-section and other birth interventions (such as pitocin). During this time (and before), a warm bath may help with the pain, as well as relaxation and support.

    Keep track of the baby’s heartbeat with a hand-held device.

    Skip the constant fetal monitoring, as research has not proven it to be safe for baby. It is also quite cumbersome and interfering with the natural process of labor. By using a doppler (fetal stethoscope),  the risk of having a c-section drops drastically, as does the chance of needing forceps or vacuum to aid baby in being born.

    Obtain continuous, one-to-one support from a labor companion such as a doula.

    Hiring a doula or preparing your partner through a partner-based coaching childbirth class (such as the Bradley Method), reduces the chance of receiving a c-section, accepting pain medication, and

    This shortens labor and reduces the likelihood of cesarean birth, use of pain medications, and increases the probability of a positive birth experience.

    Drink clear liquids during labor.

    Not eating or drinking in labor at the hospital is an outdated practice that can potentially spiral labor into interventions. Using an IV does not support the woman’s body in labor to move as needed. It is now recommended to drink plenty of clear liquid and the committee is currently still researching eating as needed while laboring.  I can assure you that eating helps keep energy levels where they need to be, and food should be consumed if wanted.

    Avoid a procedure to break the membranes (bag of waters).

    Having your water broken does not shorten labor or prevent a c-section. It is an intervention and should be left to break when the body forces it to. If it does not break before baby enters the world, it is perfectly safe and healthy to be born “in the caul.”

    Use upright positions and/or move about during labor.

    Work with gravity during labor. Laying on your back is the opposite of productive. This increases the intensity of contractions and stretches the length of the labor. Choosing to be upright, moving around will shorten labor time and reduce the chance of having a c-section.

    Try various drug-free pain relief methods.

    Instead of planning to ‘take the drugs’ once labor begins, understand that a drug-free birth has no adverse effects and includes many benefits for both mother and baby. There are too many techniques to list to handle labor without drug interventions, but some include:

    • Water
    • Movement
    • Relaxation
    • Breathing Techniques
    • Meditation

    Use position of comfort and choice when pushing and giving birth.

    As previously stated, lying on the back fights gravity, increases pain, and lengthens labor. This can be said for the second stage – or pushing, as well. There are several positions in which help baby move through the birth canal easier, and even aid in preventing tearing. Hands and knees, squatting (shorten birth canal by over 10%!), side-lying, or whatever is comfortable for the mother – that is the best position to push.

    Rest and await the urge to push after full dilation.

    Couples assume that 10cm means PUSH! The ACOG now recommends waiting to push until the body begins pushing on its own. There is a natural timeframe that the body creates after reaching maximum dilation. This time allows for rest and energy rebuild to effectively aid the body in birthing the baby.

    Push according to one’s own urges and preferences.

    Gone are the days with pushing for a count of 10 or bearing down and hold the breath to push as hard as possible. These tactics have been shown to cause possible harm and are no longer recommended. Allowing the woman’s body to be its own guide is now understood to be the best way to birth.

    Following these recommendations can aid in achieving the birth a mother desires, one with little to no intervention. This is the absolute healthiest way for a baby to enter the world.

    While pregnant, utilizing a knowledgeable chiropractor can also provide many benefits for mother and baby. I believe that opening your mind to alternative care and exploring additional birth team members can help make the journey of pregnancy and birth a more positive experience.

    Reference:

    http://www.nationalpartnership.org/research-library/maternal-health/professional-recommendations-to-limit-labor-and-birth-interventions.pdf

    http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth

    http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

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  • Doulas and Their Impact on Birth

    31 January 2017
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    doula1

     

    When pregnant mothers frequent my office, we often discuss their birth plan along with their pregnancy experience. Typically, women committed to chiropractic care are of the more natural mindset and plan for unmedicated births whenever possible. One of the biggest pieces of advice that I offer is to hire a doula. Not just any doula, but a doula who you feel connected with.

    You will read about how a doula will support a birthing mother and help educate couples about birth; some are even known as postpartum doulas and help after the baby is born. But what you will not read is about the emotional support, the true in-the-moment help that a doula provides. There is an unselfish act of giving herself – her entire being – to ensure that a mother brings her child into the world safely, and as peacefully as possible. A doula does not push her believes or choices on families, but instead, she accepts and fights for what a mother wants. She will spend hours, even days, foregoing her own needs to support the birthing mother. These are the events that the research cannot tell you.These are the stories you must hear from mothers who have given birth with a doula present.

    There is also a science behind childbirth and doulas. Actually, there is quite a bit of science. Researchers have studied how doulas impact birth, and the results are nothing less than I would expect. Labors involving doulas are significantly shorter with greater progress (dilation) made before entering a hospital or place of birth – and far more progress before the accepting of medical interventions (epidural). Research also shows the having a doula lowers the risk of an unplanned cesarean section and increases APGAR scores at both 1 and 5-minutes post-birth.

    to a 2013 study published in the Journal of Perinatal Education, “Doula-assisted mothers (are) four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may increase the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.”

    It is more than just emotional, physical, and educational support that a doula gives to a birthing woman. She is her advocate. Her voice helps account for the reduced need for interventions during birth, less complications, and an overall happier experience during and after birth.
    Research shows that doulas create a:

    • 12% increased chance of spontaneous vaginal birth
    • 28% decreased chance of c-section
    • 31% decreased chance of accepting an epidural
    • 34% decreased chance of being unhappy with the birthing experience as a whole

    It is important to note that doulas can be utilized for any birth situation. A planned c-section still needs support and advocating – just as much as an unmedicated vaginal birth.

    I feel as though many couples are afraid of having “another body” in the room with them, but to these couples, I encourage you to reach out and interview doulas in your area. The right doula will never feel like a body taking up space, but as a partner in your birthing team. Hospital nurses have been reduced and their time is spread thin. The days when a nurse was by a woman’s bedside throughout her labor as a supportive figure are gone. This paired with our society’s need to intervene with the birthing process, leaves many couples feeling defeated. A feeling that belongs nowhere near pregnancy, labor, or birth.

    One of the largest take aways from the research is this: There is absolutely zero harm that has been proven in having a doula present for birth.

     

    http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2006.00067.x/full

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/

    https://www.dona.org/what-is-a-doula/benefits-of-a-doula/

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003766.pub4/abstract

    http://europepmc.org/abstract/med/10631824

    http://pediatrics.aappublications.org/content/114/Supplement_6/1488.full

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  • Birth Trauma and Chiropractic Care

    26 January 2017
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    Not every birth is traumatic, but many are. What is a traumatic birth, you ask? The term is subjective to each woman (and baby) who experiences the birth. While one mother may consider a 48 hour natural labor traumatic, another may not. The key is to understand that a traumatic experience depends on how a woman feels about her birth. Were forceps or a vacuum unexpectedly utilized? Was an episiotomy given without consent? Was baby ‘stuck’ at an odd angle for a prolonged period of time? Not one mother will share the same story, but thousands can share their version of traumatic birth.

    A birth that doesn’t go as planned can cause post-traumatic stress disorder, postpartum depression, impact the breastfeeding relationship or milk production, effect relationships -including the bond between mother and baby, have physical implications for mother and/or baby, and have lifelong effects that can impact both mother and child.

    It is assumed, through little research, that at least 1-2% of all mothers develop post-traumatic stress disorder after a difficult birth. With the lack of ample research done in the field of traumatic birth experiences and their overall impact on mothers and infants, I choose to believe in the word of the mothers and the physical differences I see in these families after their traumatic births. I have witnessed many infants in need of immediate chiropractic care after their challenging entrance to the world, and I have also seen many who have managed to only need a slight adjustment. The thing to remember is that it is important to be seen by a good family chiropractor.

    According to a 2004 study, an undefined prolonged second stage (pushing) of labor results in the use forceps. (This is a topic for another post, as there should be several natural things done prior to grabbing forceps.) The use of forceps is linked to facial injuries, cranial distortions, injuries to the brainstem and spinal cord, and subluxation to the infant. They are also linked to meningeal tears and injuries to blood vessels, muscles and ligaments, and the nerves and bone structures. The same study included the possible side effects of utilizing a vacuum for extracting a baby during birth. This is linked to cephalohematomas, lacerations, and subluxation.

    trauma

    Keeping in mind how subluxations tend to run hand-in-hand with sensory processing disorder, adhd, sleep issues, and so many other common chronic problems children are faced with today, it is not a far stretch to consider that a child’s birth may be the origin of these problems.

    Erb’s Palsy, “a form of obstetric brachial plexus disorder (A plexus is a network of nerves that supplies a specific area of the body), is an injury that occurs when the nerves in a baby’s upper arm are damaged. It typically affects one or two of every 1,000 babies. The injury usually occurs as a result of a lesion at Erb’s point, the area near the baby’s neck where the fifth and sixth cranial nerves merge to create the upper point of the brachial plexus.” This is caused by one or more of the following, with birth trauma being the most common:

    The use of forceps and/or vacuum extraction tools during delivery

    Large infant size
    Small maternal size
    Excessive maternal weight gain
    Second stage of labor lasting over an hour
    Infants with high birth weight
    Infants in the breech position
    While chiropractic care may not cure severe cases of birth traumas, it is a tool that may provide help in lessening symptoms, improving the quality of life, and allowing the body to be in its best alignment possible.

    Birth trauma is often overlooked by doctors as the cause of chronic problems, and over time, as the child grows, it becomes a thought less considered. But the truth is that birth trauma is real, and the impact it can have on a mother or child needs to be addressed. Psychological therapy, physical therapy, chiropractic care, acupuncture, and other healing techniques should all be considered following an extremely difficult birth.

    Resources:

    http://journals.lww.com/greenjournal/Abstract/2004/03000/Immediate_Maternal_and_Neonatal_Effects_of_Forceps.18.aspx

    http://www.cmaj.ca/content/156/6/831.short

    http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2010.05391.x/full

    http://www.tandfonline.com/doi/abs/10.1080/13548500600708409

    http://bjp.rcpsych.org/content/166/4/525.short

    http://www.tandfonline.com/doi/abs/10.1080/13548500600708409

    http://www.birthinjuryguide.org/erbs-palsy/

    https://www.ncbi.nlm.nih.gov/pubmed/659282?dopt=Abstract

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  • Writing a Birth Plan

    3 January 2017
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    Pregnant belly and sticker notes, pregnancy ideas. Woman planning reminder and task. Choosing new born baby name, boy or girl.

    It can be so intimidating that most women forego writing one altogether.

    Don’t let that be you. Skipping your birth plan means that you are skipping the educational aspect of giving birth. You are walking in blind – uniformed – and unprepared for the possibilities that lie ahead.

    You may have the birth of your dreams without a birth plan in hand, but if just one domino falls, your birth has the chance of not being what you were hoping for. How does a birth plan change any of that, you ask?

    Like most things in life, it isn’t so much about the end result, but the journey to get there. Your birth plan is a culmination of your research; a brief proposal of what you would like, how things should be handled, and how you deserve to be treated.

    Before writing your birth plan, tour your birthing facility and schedule a time to talk with your doctor (or practice of doctors), or midwife. You cannot begin this until all of your questions are answered. You need to know what the standard of care is from the moment you enter the facility until the second you are wheeled out. (Are you allowed to walk out? -simple questions like that need to be asked too!)

    Once you have a basic timeline of events, you can dig into the research and figure out your priorities. I have yet to ever see two identical birth plans.

    Make sure to bring your birth team a copy of your plan after it is written. Pack a few copies in your birth bag and have your partner pull them out upon arrival when you are in labor. Everyone can receive a copy – the doctor, all nurses, anyone who enters the room can be asked to take 2 minutes to ‘Please review my partner’s birth wishes. We would really like to be team through this, and I want her priorities to be known. Thank you!’

    Now it’s time to write.

    The easier the plan is to read, the higher the chances are that it will be read. There are three basic formats to choose from:

    Bullet Points: Simple, brief statements listed under different headings (example: Early Labor, Active Labor, 2nd Stage, 3rd Stage, After Delivery for Mom and Baby)

    Chart: Each procedure listed with the mother’s thoughts or wishes next to it, in charted form.

    Paragraphs: Harder and longer to read, paragraph format is typically done under headings like bullet points, but contains longer thoughts.

    *Remember not to include WHY you are choosing these things, that does not matter. Keep is SIMPLE and include everything important to you.

    A birth plan is not written in stone. No matter what though, YOU SHOULD NEVER BE PUSHED OR TALKED INTO ANYTHING. If situations arise, take the time to talk about your options, risks, and make informed decisions.

    This is a sample birth plan. Yours will be your own, but feel free to start here and add/delete and alter as you see fit. It is based on a plan for a natural hospital birth without medical intervention. Remember, you may not agree with my plan, but that’s the beauty of it – you get to make your own!

    SAMPLE BIRTH PLAN

    I would like to have an unmedicated, peaceful birth with the help and support of you as my birth team. My partner and I are educated and understand that unexpected situations may arise. If anything occurs, please help us to continue on the most natural path as possible, granting us time to make decisions and supporting us through the process.

    In case of emergency, save both mother and baby in any way possible.

    *There will be a photographer with us, and she is allowed to stay with us in all situations.

    Before Labor:

    • I would like to let labor begin naturally, even past my due date, and do not want any interventions to begin labor.
    • If water breaks before labor begins, I would like 48-72 hours before any interventions are suggested. I agree to have my fluid levels monitored.

    Early Labor:

    • If I arrive before active labor has begun, I would like to leave and come back further into labor – even if my water has broken.
    • I deny antibiotics for GBS and will watch for fever and signs of illness after birth.
    • I would prefer no heparin lock be put in place, but will compromise if an IV will not be attached.

    Active Labor:

    • DO NOT OFFER PAIN MANAGEMENT MEDICATIONS.
    • My partner will remain with me and be included in all discussions.
    • I would like a peaceful, calm, and intimate environment with minimal interruption.
    • I would like to move freely and labor in any position comfortable.
    • I will eat and drink throughout labor.
    • I would like access to the birthing tub (if available).
    • No cervical checks unless requested.
    • No artificial rupturing of membranes (water breaks naturally or baby is born in the caul).
    • I would like baby’s heartbeat to be monitored intermittently through Doppler or stethoscope. No electronic fetal monitoring, internal monitoring, or wireless monitoring. If continuous monitoring is needed, wireless monitoring will be permitted so I can still walk freely.
    • As long as my baby and I are fine, I would like to be free of time limits and not have my labor augmented.

     

    2nd Stage Labor:

    • No episiotomy unless I am naturally tearing toward my clitoris.
    • No vacuum or forceps. Instead a change of position.
    • I will wait until my body naturally begins pushing before I push.
    • Please do not instruct my pushing, I will listen and aid my body, taking breaks when needed.
    • I do not want to be laying on my back to push.
    • I would like access to the squatting bar and birth stool.
    • I would like to ‘catch’ my baby, or have my partner catch the baby.
    • My partner will announce the baby’s gender.
    • Baby will immediately be placed skin to skin on my chest.
    • We will let the umbilical cord pulse to completion before clamping.

    3rd Stage Labor:

    • No medical interventions to birth the placenta.
    • I wish to see the placenta.
    • Placenta will be kept in the provided cooler to be encapsulated.

     

    C-Section:

    • A c-section will only be performed once all options have been exhausted and it is a medical emergency.
    • My partner will remain with me throughout the procedure.
    • I would like to have feeling and the ability to move my arms. (Avoiding general anesthetic.)
    • I would like a family-centered c-section with a clear curtain, mirror, and inclusion in the birth conversation.
    • Baby will be placed directly on my chest with the umbilical cord and placenta still attached to the baby.
    • Take extreme care with incision and sutures to support a future VBAC and more pregnancies.

    Following Birth:

    • My partner or child will cut the cord after it has finished pulsing.
    • No separation from baby. Hold off on any newborn checks. Anything needed can be done with baby on my chest.
    • In an emergency, my partner will accompany the baby everywhere needed.
    • Breastfeeding will be attempted before any weighing or measuring takes place.
    • All procedures will be held off until initial bonding has been established.
    • Vernix will be rubbed into the baby’s skin, please do not wash it off.
    • I decline the Vitamin K injection and antibiotic eye ointment.
    • NO VACCINES: I decline the hepB vaccine and any other vaccines or injections offered.
    • DO NOT CIRCUMSIZE if baby is a boy (or a girl).
    • Do not bathe baby.
    • No formula.
    • No Bottles.
    • No pacifiers.
    • I would like a lactation consultant to be available as soon after delivery as possible.

     

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  • Vaginal Seeding For C-Sections

    6 July 2016
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    Doctor holding newborn baby.

     

    C-sections occur in more than 1/3rd of births in the US now.  It is more than just a trend, and seems to only be rising.

    Research shows us that babies born by cesarean have increased chances of obesity, asthma, celiac disease, autism, chronic illnesses, and type 1 diabetes later in their lives. This research suggests that it is the differences in the gut flora that plays a part in the rise in these diseases.

    Allowing the body to labor on its own, without intervention, provides many benefits for posi both mom and baby, but allowing baby to pass through the birth canal takes the cake, folks. Apparently, our bodies are so amazing that we not only grow humans, but our own gut flora is passed to those humans as they grow (through the placenta).

    It gets even better! Our gut flora travels from our gut into the birth canal during labor.  These bacteria then are absorbed through baby’s skin, eyes, nose, mouth, and genitals as he passes through the birth canal and is welcomed to the world.

    By having these bacteria absorbed into their bodies, babies have a decreased risk of the above mentioned illnesses, as well as many more.

    I know that 1 (or 2) out of every 3 of pregnant women reading this will end up electing or requiring a c-section for birth, but YOU are who I am writing this for.  Science has found a way for you to grace your baby with your ‘seed.’

    If you are HIV negative, and having a C-Section, I highly recommend you read on.  If you are GBS positive, talk to your doctor about vaginal seeding.

    What is Seeding?

    Dr. Maria Gloria Dominguez-Bello, an associate professor in the Human Microbiome Program at the NYU School of Medicine, presented the process to do what is called an inoculum or “seeding” for the infant.

    1. Take a piece of gauze soaked in sterile normal saline
    2. Fold it up like a tampon with lots of surface area and insert into the mother’s vagina
    3. Leave for 1 hour, remove just prior to surgery and keep in a sterile container
    4. Immediately after birth apply the swab to the baby’s mouth, face, then the rest of the body

    Yes, it is recommended to take vaginal swabs from the mother and putting them over the body and in the mouth of the baby to help restore the delicate balance for babies who were born by cesarean. This new research was recently shared at a conference of the American Society for Microbiology by a group of other physicians.  It is now being practiced across the country by doctors who are up to date on their research.

     

    Vaginal Birth vs. C-Section Birth

    “Vaginal birth triggers the expression of mitochondrial uncoupling protein 2 (UCP2) in mice, which is important for improving brain development and function in adulthood. The expression of this protein was impaired in mice born via caesarean section.  The communication between our guts and brains appears to rely, in part, on the vagus nerve, and is bidirectional in nature as reported in this 12-year prospective study that looked at relationships between gut problems like irritable bowel disease, anxiety, and depression.”

    http://articles.mercola.com/sites/articles/archive/2012/08/23/trimester-pregnancy-affects-baby-health.aspx

    http://articles.mercola.com/sites/articles/archive/2014/04/17/psychoneuroimmunology-inflammation.aspx#_edn13

    There is a large difference between the microbiome of a baby born vaginally compared to a baby born by c-section. During a vaginal birth the baby is seeded by the mother’s vaginal and faecal bacteria, as well as bacteria from her gut.  A baby born by c-section is seeded by the bacteria in the hospital environment and his mother’s skin.  These bacteria are incredibly different, and these differences may be the reason for the long-term increased risk of some diseases for babies born by c-section.

     

    l1

    http://www.cmaj.ca/content/185/5/385

    http://pediatrics.aappublications.org/content/118/2/511?variant=long&sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

    http://www.ncbi.nlm.nih.gov/pubmed/24390916

    With interventions like Pitocin, antibiotics, C-section and formula feeding, the gut flora transfer from the mother to baby is interfered with or missed completely, leaving the baby’s microbiome  “incomplete”.  This means that the baby’s immune system may never develop to its full potential.

    Most Beneficial Bacteria

    The most beneficial gut flora are found in babies who are born at full term (39 weeks or further), vaginally (unmedicated) at home, and are breastfed exclusively.  This is because these babies come in contact with ONLY the bacteria of their family during the prime ‘seeding’ the period.

    http://pediatrics.aappublications.org/content/118/2/511?variant=long&sso=1&sso_redirect_count=2&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A%20No%20local%20token&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

    The following are ways you can increase the chances of positively seeding your baby:

    • Have a vaginal birth at home.
    • Avoid vaginal contact: cervical checks, etc.
    • Avoid unnecessary antibiotics during labor. If antibiotics are required, consider probiotics for mother and baby following birth.
    • If the baby is born by c-section, follow the procedure of vaginal swabs to ‘seed’ the babies. The preliminary results are that the microbiome of swabbed babies are more similar to vaginally born babies.
    • Breastfeed.

    How to Help After Birth

    After birth,  the baby continues to receive  gut flora through contact with the environment and breastfeeding. The differences in the gut of breastfed babies compared to formula fed babies is immense. The beneficial bacteria are transported to the baby’s gut by breastmilk. The gut health of a formula fed baby plays into the health risks and chronic illnesses linked to formula.   http://www.cmaj.ca/content/185/5/385 and http://www.livescience.com/26312-gut-bacteria-infant-colic.html

    Ways to help increase positive gut flora:

    • Skin-to-Skin:  Immediately following birth, and in the first days, baby should spend a lot of time naked on his/her mother’s chest skin-to-skin.
    • Avoid bathing baby for at least 24 hours after birth, and then only use plain water for at least 4 weeks. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2315785/
    • Minimize the handling of baby by non-family members during the first weeks.
    • Exclusively breastfeed.
    • Avoid giving baby unnecessary antibiotics.  http://www.nature.com/ijo/journal/v35/n4/full/ijo201127a.html
    • Probiotics may also be beneficial for babies suffering from colic.

     

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